Walking the streets of Yangon, there is an unmistakable smell of change in the air. As you work your way through the hazy smoke and clattering utensils of the street food vendors mixing local Burmese delicacies while chewing on Beetle nuts, you see the smiling face of the bus ticket collector, the direct gaze of the elderly woman arranging her mango stand, and the open embrace of the little girl pulling you over to see a treasured T-shirt that she thinks you can not refuse. Back at her stall, swaying in all its glory is the image of President Obama shadowing the Burmese freedom movement hero and Nobel Laureate Aung San Suu Kyi with large letters OBURMA above it.
Burma, or Myanmar as it has been known since 1989, is a country of 63 million people which provides the test case for the current administration's "Pivot to Asia policy". Now the people of Myanmar get to ask the question that those in the emerging nations of Middle East, Africa, and South America have asked before them: "Does America have the will and resources to help complete its commitment towards a democratic and free Myanmar?"
The stakes are high as Myanmar enjoys a privileged geopolitical position wedged between China and India which together comprise a third of the world's population and recent consistent growth engines.
Although most of the dialogue is taking place in the urban centers, Myanmar's real change has to come from the rural areas. Myanmar is no different than most of the emerging world's economies in that it may become a victim of its own success. As port cities like Dawei become major regional transit points for countries like Thailand, Cambodia, and Vietnam, Myanmar will find itself building a rapid over-utilized road system that can bring cheap labor to the major port cities. This will invariably lead to an increasing incidence of trauma from over utilization of undeveloped roads and overpopulated minivans and motorbikes. With increasing need for an industrialized labor force, untrained workers will join working conditions with inadequate management and safety checks as demonstrated in the recent Bangladesh garment factory disaster at Rana Plaza.
There are over 300 million occupational injuries every year with an additional 50 million people injured annually in road traffic accidents according to a May 2013 article in the New England Journal of Medicine. In 2010, over 5 million people worldwide died from injuries which is 30% higher than the number of deaths caused by HIV/AIDS, malaria, and tuberculosis combined. Ninety percent of these injuries occur in developing countries. World Health Organization has predicted that by 2030, road accidents will be the 5th leading cause of death worldwide. With each death it is estimated that there are 50 people with significant permanent disability essentially removing that person from the active workforce. At present around 25 percent of all hospital beds in developing countries are occupied by patients with road traffic injuries. This was certainly echoed by the recent visit of the surgical team of Mission: Restore which brings free education for complex reconstructive surgery for patients suffering from burns, accidents, trauma, and congenital or acquired defects.
At Yangon General Hospital founded by the British in 1927, you will find a dilapidated plastic surgery clinic with iron gates to keep out the stray dogs while families picnic outside on the grounds of the hospital waiting their turn to be seen by the understaffed but wonderfully attentive and dedicated plastic surgeons. Myanmar also represents the typical scenario of the emerging world surgical epidemiology where a country of 60 million people only has 6 reconstructive surgeons in 4 medical centers. The rapid economic growth of low and middle-income countries ensures that this trend will continue, probably even increase, for the foreseeable future. Health care systems of poor countries cannot cope with this surge of injured patients. During a recent visit, we noticed that the majority of the wards were filled with patients from road accidents, or domestic trauma that was initially poorly addressed by the district hospitals leading to infections or contractures that made the re-operative surgery more demanding and complicated. That is why Mission: Restore is focused on Myanmar to change this paradigm by training the trainers in health education to improve long-term outcomes.
In many ways Myanmar represents the best and the worst of the emerging world: A great country with an illustrious past and culture, motivated leadership, and a sympathetic world of investors who want to see it grow and prosper. On the other hand, a country that is simply not prepared enough to enter this global sprint to economic victory as it lacks the fundamental infrastructure to help it succeed. President Obama can make the rest of the world believe in "OBurma Care" by encouraging various NGOs to help build the infrastructure and health care and education needs of Myanmar over the next decade. This will require funding as well as strong cooperation through networks such as the Clinton foundation who have solid relationships in the region. The long-term success of the American "Pivot to Asia" will require a deep and long-term commitment to the region and there is no better place to show it than Myanmar.